Background High incidence of late-onset sepsis (LOS) in preterm infants contributes to neonatal morbidity. Therapeutic outcomes of LOS have deteriorated as a result of increased antibiotic resistance problems, mainly from ESBL isolates. Controlling risk factors is important in reducing morbidity and mortality as well as providing guidance for antibiotic selection. Objectives To determine the risk factors of LOS due to ESBL-producing bacteria in preterm infants. Methods This is a retrospective study. The inclusion criteria was neonates diagnosed with late-onset neonatal sepsis by clinical signs and a positive blood culture. The blood culture result and characteristics patients as secondary data were extracted from medical records within the hospital facilities and the institutional database of the Neonatology Department of Universitas Brawijaya (January 2019 to March 2021). Statistical analysis was done to compare characteristics of the patients in the ESBL positive group to those in the ESBL negative group to assess the potential risk factors. Results Among 124 preterm infants with LOS, 62 of them were ESBL-positive case subjects and the other 62 were non-ESBL-producing control subjects. Gram-negative bacteria were the most common pathogens identified, with 96% (n=59) of them being the ESBL-producing strain, predominated by Klebsiella pneumoniae (n=56). Factors significantly correlated with the occurrence of LOS-ESBL included prior history of invasive procedures (OR 3.13; 95%CI 1.45 to 6.73; P=0.00), central access insertion (OR 9.54; 95%CI 3.7 to 24.2; P=0.00), and parenteral nutrition (OR 6.03; 95%CI 2.77 to 13.16; P=0.00). Central access insertion had the strongest influence (Exp(B) 6.98; P= 0.00). Conclusion Prior invasive procedures, central access insertion, and parenteral nutrition had significant correlations with the occurrence of LOS-ESBL in preterm infants. Central access insertion is a predictive factor for LOS-ESBL.

Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.

Background Diagnosis of neonatal sepsis is still challenging. Several diagnostics test have been developed to help diagnose of neonatal sepsis, but sometimes it could not be done routinely in limited facilities. Procalcitonin (PCT) and red cell distribution width (RDW) have been reported to have correlations with the risk of developing sepsis. Objective To evaluate the diagnostic value of combined of PCT and RDW as markers for neonatal sepsis in preterm infants. Methods A cross sectional study was conducted in the neonatal ward, Syaiful Anwar hospital, Malang, East Java. The subjects were preterm infants with neonatal sepsis. Blood culture were taken as the gold standard and RDW and PCT levels were assessed as the comparison. All of the test were performed at the begining of the study. The incidence of sepsis was reported as the main outcome. The data obtained were processed and analyzed using the receiver operating characteristic (ROC) method to obtain the area under curve (AUC) value. Results Fifty-five preterm infants presenting neonatal sepsis were enrolled in this study. The combination of RDW and PCT showed AUC 0.814 (P=0.199) with sensitivity and specificity 78.9% and 80.6%, respectively in diagnosing neonatal sepsis compared to blood culture. Conclusion Combination of RDW and PCT as markers of sepsis in preterm infants have good sensitivity and specificity.

Background Procalcitonin (PCT) level is one of known biomarker in septic diagnosis, but limited studies report its benefit in predicting the outcomes of children with sepsis. Neutrophil to lymphocyte (NLR) and mean platelet volume (MPV) are simple biomarkers of inflammation that can be measured in routine hematological examination which role in predicting organ dysfunction remain unclear. Objective To understand the correlations between PCT level, NLR, and MPV, tested in the first day of admission with outcomes of septic children in intensive care unit. Methods This retrospective cohort study obtained the data from medical record of pediatric patients admitted in PICU and HCU since January 2019. The inclusion criteria were children aged 1 months to 18 years with sepsis; whie exclusion criteria were patients with congenital heart disease, hematologic disease, malignancy, and length of care in intensive care unit less than 3 days or more than 28 days. The PCT, NLR, and MPV levels were assessed in the first day of admission. Organ dysfunction was identified using qSOFA score more than 2 points.   Results Sixty-nine septic children were reviewed. Procalcitonin level in the first day of admission correlated significantly with qSOFA score in the third day of admission (R= 0.639; P=0.000); as well as with mortality (R=0.747; P=0.000). Receiver operating characteristic (ROC) curve of PCT level in the first day of admission had area under curve (AUC) of 0.922 to predict organ dysfunction (cut off 3.425; sensitivity 95.8%; specificity 52.4%) and AUC of 0.952 to predict mortality (cut off 21.165; sensitivity 96.4%; specificity 78%). Moreover, NLR in the first day of admission correlated significantly with qSOFA in the third day of admission (R=0.407; P=0.001), but did not correlate with mortality. The ROC of NLR to predict organ dysfunction was 0.829 (cut off 3.52; sensitivity 87.5%; specificity 66.7%). There was no correlation between MPV in the first day of admission with qSOFA score in the third day of admission neither with mortality. Linear regression test showed that PCT level and NLR in the first day of admission simultaneously had correlated with qSOFA score in the third day of admission (R=0.696; P= 0.000) and mortality (R=0.748; P=0.000). Meanwhile, PCT and MPV simultaneously had correlation with qSOFA score in the third day of admission (R=0.688; P=0.000) and mortality (R=0.733; P=0.000). Moreover, NLR and MPV simultaneously had correlation with qSOFA score in the third day of admission (R=0.453; P=0.002). All three independent variables (PCT level, NLR, and MPV) simultaneously correlated with qSOFA score in the third day of admission (R= 0.744; P=0.000) and mortality (R=0.739; P=0.000). Conclusion There are significant correlations between each, PCT level and NLR in the first day of admission with qSOFA score in the third day of admission as well as with mortality. There is no  correlation between MPV in the first day of admission with qSOFA score in the third day of admission, neither with mortality. There are significant correlations between PCV level and NLR with or without MPV with qSOFA score in the third day of admission as well as with mortality.

Abstract. Background: Febrile neutropenia in malignancy children increase the risk of infection, morbidity and mortality. Microbiologically documented infection in pediatric malignancy has not been studied in Saiful Anwar Hospital. Purpose: Determine profile of blood, urine, sputum, and wound bed culture and antimicrobial sensitivities pattern in pediatric malignancy patients with febrile neutropenia. Methods: Pediatric malignancy patients with febrile neutropenia and microbiologically documented infection admitted to dr Saiful Anwar General Hospital Malang, were studied from 2016 to 2019.  Bacterial and fungal etiology were identified, along with antimicrobial sensitivities patterns. Results: 53 (17%) of 307 pediatric malignancy patients with febrile neutropenia experienced 75 episodes of microbiologically documented infection. 40 (53,3%) gram-negative and 34 (45,3%) gram-positive isolated from 75 isolated pathogens. The most common gram-negative were Klebsiella pneumonia (n=15) and Escherichia coli (n=8). The most common gram-positive were Coagulase-negative Staphylococci (n=14) and Enterococcus faecalis (n=7). Escherichia coli, Coagulase-negative Staphylococci, Enterococcus faecalis, and Staphylococcus aureus were 100% sensitive to all tested antimicrobials. Klebsiella pneumonia and Acinetobacter baumanni were 100% sensitive to almost all tested antimicrobials. Pseudomonas aeruginosa was found less sensitive (0-80%) to all tested antimicrobials. Conclusion: Investigation of antimicrobial sensitivities of these organisms may guide successful antimicrobial therapy and improve quality of pediatric malignancy care. Abstrak. Latar Belakang: Demam neutropenia pada keganasan anak meningkatkan risiko infeksi, morbiditas dan mortalitas. Microbiologically Documented Infection merupakan masalah utama di dunia, namun belum dilakukan penelitian di RSUD Dr. Saiful Anwar. Tujuan: Melihat gambaran kultur darah, urine, sputum, dan dasar luka dan pola sensitivitas antimikroba pada keganasan anak dengan demam neutropenia. Metode: Pasien keganasan anak dengan demam neutropenia di bangsal Hemato-onkologi Departemen Ilmu Kesehatan Anak RSUD Dr. Saiful Anwar Malang dan terdiagnosis Microbiologically Documented Infection pada tahun 2016-2019, ditentukan etiologi, serta pola sensitivitas antimikroba. Hasil: Dari 307 pasien keganasan anak dengan demam neutropenia, 53(17%) pasien mengalami 75 episode microbiologically documented infection. Didapatkan 40(53,3%) bakteri gram negatif dan 34(45,3%) gram positif dari 75 hasil kultur. Bakteri gram negatif yang paling banyak ditemukan adalah Klebsiella pneumonia (n=15) dan Escherichia coli (n=8), serta Coagulase-negative Staphylococci (n=14) dan Enterococcus faecalis (n=7) pada gram positif. Escherichia coli, Coagulase-negative Staphylococci, Enterococcus faecalis, dan Staphylococcus aureus 100% sensitif terhadap semua antimikroba yang diuji. Klebsiella pneumonia dan Acinetobacter baumanni 100% sensitif terhadap hampir semua anitmikroba yang diuji. Pseudomonas aeruginosa memiliki sensitivitas rendah (0-80%) terhadap semua antimikroba yang diuji. Kesimpulan: Penelitian tentang sensitivitas antimikroba pada organisme tersebut dapat menjadi panduan untuk keberhasilan terapi dan meningkatkan kualitas pelayanan pada keganasan anak.